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General NPI Number Information
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NPI Number | 1043003015
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Entity Type | Organization
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Legal Business Name | PREMIER MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 05/23/2025
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 701 FOULK RD STE 1G
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City | WILMINGTON
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State | DE
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Zip | 19803-3733
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Country | US
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Telephone | 302-652-5109
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Fax | 877-575-3337
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Provider Business Mailing Address
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Address Line | 620 STANTON CHRISTIANA RD STE 101
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City | NEWARK
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State | DE
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Zip | 19713-2134
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Country | US
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Telephone | 302-449-9314
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Fax | 877-575-3337
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Authorized Official
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Title or Position | OWNER
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Name | LYRON ANDRE DEPUTY
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Credential |
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Telephone | 302-652-5109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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